Burnout among Internal Medicine Residents

In a study that included nearly three-fourths of all internal medicine residents in the U.S. in a recent academic year, suboptimal quality-of-life and dissatisfaction with work-life balance were commonly reported, as were burnout symptoms of emotional exhaustion, which were associated with higher levels of educational debt, according to a study in the September 7 issue of JAMA, a medical education theme issue.

“Factors such as physician burnout, depression, job dissatisfaction, and low quality of life (QOL) have been associated with negative effects on patient care, including major medical and medication errors, suboptimal care practices, and decreased patient satisfaction with medical care.

Despite the relevance of physician well-being to patient care outcomes, little is known about patterns of distress across demographic factors. To our knowledge, there has not been a nationally representative examination of factors that may be associated with well-being of internal medicine residents,” the authors write.

Colin P. West, M.D., Ph.D., of the Mayo Clinic, Rochester, Minn., and colleagues surveyed a large national cohort of internal medicine residents to more fully understand the prevalence of resident distress across demographics as well as its association with medical knowledge, hypothesizing that distress would be associated with greater educational debt, lower test scores, and decreased learning.

The study of internal medicine residents used data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. The IM-ITE is a standardized 340-item multiple-choice self-assessment examination offered yearly to internal medicine residents to evaluate progress in training by identifying areas of deficiency that require further learning.

The study included 16,394 residents (7,743 U.S. medical graduates and 8,571 international medical graduates), representing 74.1 percent of all eligible U.S. internal medicine residents in the 2008-2009 academic year. Quality of life and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses.

The researchers found that overall QOL was rated as being "as bad as it can be" or "somewhat bad" by 2,402 of 16,187 responding residents (14.8 percent). Regarding work-life balance, 32.9 percent reported being somewhat or very dissatisfied. Symptoms of emotional exhaustion at least weekly were reported by 7,394 of 16,154 residents (45.8 percent), and 4,541 of 15,737 (28.9 percent) reported symptoms of depersonalization (such as a feeling of being detached or unable to feel emotion) at least weekly. Overall, at least 1 symptom of burnout was reported by 8,343 of 16,192 residents (51.5 percent).

The authors also found that emotional exhaustion and depersonalization increased as educational debt increased. Compared to residents having no debt, residents having more than $200,000 of debt had a 59 percent higher odds of experiencing emotional exhaustion; 80 percent higher odds of experiencing depersonalization; and 72 percent higher odds of experiencing burnout.

Other findings included that IM-ITE score decreased as educational debt increased; that the association of debt with IM-ITE score was stronger for international medical graduates than for U.S. graduates; that international medical graduates were markedly less likely than U.S. graduates to report high levels of emotional exhaustion or depersonalization; and that decreased QOL, decreased satisfaction with work-life balance, and increased frequency of burnout symptoms were associated with lower IM-ITE scores.

“Regardless of the explanation, internal medicine residents with greater degrees of emotional exhaustion and debt, and lower QOL levels, consistently scored less well on the IM-ITE and did not recover to the level of their colleagues over the course of their training. Additional studies are needed to better understand these relationships and their effect on clinical competency. In particular, as debt relief programs are developed for physicians in training and in practice, their effect on both well-being and patient safety should be assessed,” the authors write.

JAMA. 2011;306[9]:952-960.

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